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Billing Newsletter | June 2022

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COVID-19 VACCINES GUIDELINES

COVID 19 VACCINE AGES TYPE OF CODE CPT ECW CPT NAME

EFFECTIVE

J&J

(JANSSEN)

18 & OLDER

VACCINE

1ST DOSE ADMIN

91303

0031A

COVID 19 (JANSSEN) >18YRS

COVID-19 IM ADMIN (J&J) BOOSTER

COMPONENT

2/27/2021

VACCINE

91301

COVID 19 (MODERNA) >18YRS

MODERNA

18 & OLDER

1ST DOSE ADMIN

2ND DOSE ADMIN

3RD DOSE ADMIN

BOOSTER VACCINE

BOOSTER ADMIN

0011A

0012A

0013A

91306

0064A

COVID-19 IM ADMIN (MODERNA) 1ST

COMPONENT

COVID-19 IM ADMIN (MODERNA) 2ND

COMPONENT

COVID-19 IM ADMIN (MODERNA) 3RD

COMPONENT

BOOSTER-COVID 19 (MODERNA-0.25ML)

>18YRS *7990

COVID-19 IM ADMIN (0.25 ML MODERNA)

BOOSTER COMPONENT

12/18/2020

10/20/2021

VACCINE

91300

COVID-19 (PFIZER) >12YRS

PURPLE

1ST DOSE ADMIN

2ND DOSE ADMIN

3RD DOSE ADMIN

0001A

0002A

0003A

COVID-19 IM ADMIN (PFIZER) 1ST

COMPONENT

COVID-19 IM ADMIN (PFIZER) 2ND

COMPONENT

COVID-19 IM ADMIN (PFIZER) 3RD

COMPONENT

8/12/2021

10/20/2021

PFIZER

12 & OLDER

BOOSTER ADMIN 0004A COVID-19 IM ADMIN (PFIZER) BOOSTER 9/22/2021

VACCINE 91305 COVID 19 (PFIZER- GRAY) >12YRS

GRAY

1ST DOSE ADMIN

2ND DOSE ADMIN

3RD DOSE ADMIN

BOOSTER ADMIN

0051A

0052A

0053A

0054A

COVID-19 IM ADMIN (PFIZER-GRAY) 1ST

DOSE

COVID-19 IM ADMIN (PFIZER-GRAY) 2ND

DOSE

COVID-19 IM ADMIN (PFIZER-GRAY) 3RD

DOSE- IMMUNO

COVID-19 IM ADMIN (PFIZER-GRAY)

BOOSTER

1/3/2022

PFIZER

PEDIATRICS

ORANGE

*Effective 03/28/2022

CHILDREN

5-11

VACCINE

1ST DOSE ADMIN

2ND DOSE ADMIN

91307

0071A

0072A

COVID 19 (PFIZER) PEDIATRIC 5-11YRS

COVID-19 IM ADMIN CHILD - (PFIZER) 1ST

COMPONENT

COVID-19 IM ADMIN CHILD - (PFIZER) 2ND

COMPONENT

10/29/2021

Self-Pay/Underinsured Patients: Vaccine administration will be FREE. Per the Centers for Disease Control and Prevention’s

Requirements for COVID-19 Vaccination Program Providers, providers must continue to administer COVID-19 vaccines at no

out-of-pocket cost to recipients.


Process for COVID Vaccines:

Document in ECW (as any other service) by creating a progress note.

Create a claim

Adjust the claim using TERMCVD adjustment code.

*Updates found in green font.


I M P O R T A N T I N F O R M A T I O N

Patients with

balance

Please allow to pay at the

clinic. We should never turn

patients that want to make a

payment away.

Questions about balance – Billing dpto. 972-957-3000 option 2.

Payment by phone – Patient Payment Collectors: Nuvia Lucio ext.

8124

Patient Collections phone number – 1 800 711 6521

Medical Record Requests need to be sent to – Email:

mdmedical@dmrs.net / Fax (213) 225-5070 / Phone (800) 359-8520

Patient refunds

need an allowance period of 30 days to complete

processing.

Locums : Make sure progress note is signed and scanned, the correct template

is used (acute / preventive), if correct template is needed, please ask RDO.

Locum providers should never see Medicare patients.

How to code new/established visits

on the same day.

(when the patient is truly a new patient to our facilities)

PAYOR GROUP PATIENT AGE RULE CPTS YOU MAY USE

COMMERCIAL

ALL AGES

Well visits are going to be

billed as a new patient

sick visits billed as if

patient was established

99381 - 99387

99211 -99215

0 - 20 YEARS

Well visits are going to be

billed as a new patient

99381 -

99385

99201 -

99205

MEDICAID

21 YEARS AND

MORE

Well visits are going to be

billed as a new patient

Sick visits billed as if

patient was established.

99385 - 99387

99211 - 99215

If visit is done by a Locum, two separate notes will need to be attached to the patients file


R E M I N D E R S

PATIENTS' BENEFIT VERIFICATION

Please be sure we are verifying:

Benefits on all patients as well as collecting

co-pays, deductibles and/or co-insurances at

the time of the service. (please use Master

Fee Schedule for collecting deductibles / coinsurances)

Patient's benefits through TMHP and

payor's portal every time a patient returns

to clinic.

That the provider is linked to Topcare

Medical Group Inc.

Benefits to know if Sports Physical is a

covered benefit, for Superior Ambetter

PAYOR SPECIFIC

All Medicaid Insurance needs to be verified

on the 1st of every month.

If patient has a Dual Plan please make sure

you use the presentation provided "Dual

Policies" to verify insurance and load

correct Medicaid and Medicare plans.

If patient has CHC we must obtain

authorization for CPT 17340 prior to

performing.

If the patient has BCBS HMO then they

should not add BCBS PPO to the patients

account but add BCBS HMO insurance

record.

PATIENTS' INFORMATION

Please remember to update patient's

information such as address and telephone

number. Please update Medicare patient

accounts with their new identification cards.

Make sure that for children the

demographics contains

GUARANTOR/RESPONSIBLE PARTY. We

are seeing numerous account where this is

missing.

If patient with insurance signs the "Self-Pay

Form" please remove insurance from claim

at the time of creation.

PATIENT BALANCE

If patient has an outstanding balance, please

collect balances based upon our payment

arrangements and/or call CBO to resolve

with patient collections (ext. 8124)

PCP INFORMATION LOGIN

For all HMO’s, staff should update the PCP

to our provider treating the patient at the

time of service.

Amerigroup has finished loading

Amerivantage to our providers. You can call

Amerigroup and they should be able to

change PCP.

EMPLOYEE FEE SCHEDULE

If employee is coming for Office Visit,

choose "Employee Fee Schedule" and

adjust $0.01 under employee adjustment

only. Do not adjust any other service

done. Charges from "Employee Fee

Schedule" are already adjusted and should

be collected when performed.

"BIG journeys begin with

SMALL steps".

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